Because persons aged 65 years and older have a one-in-five chance of having either sympto­matic or asymptomatic peripheral artery disease (PAD), an updated management guideline recommends that people in that age group be considered for ankle-brachial index (ABI) diagnostic testing, rather than waiting until they reach the age of 70 as an earlier version of the guideline had suggested.


“Age alone appears to define a patient population at such a high risk of PAD that we can justify using a cost-effective and risk-free test like the ABI,” guideline author Thom Rooke, MD, wrote in a statement in Circulation.

The guideline, issued by the American College of Cardiology Foundation and the American Heart Association, updates 2005 recommendations. The earlier document suggested using the resting ABI to establish the lower-extremity PAD diagnosis in patients with suspected of having the condition, defined as individuals with exertional leg symptoms with nonhealing wounds, who were aged 70 years and older or who were aged 50 years and older with a history of smoking or diabetes.


The 2011 update modifies the definition of patients with suspected lower-extremity PAD to include individuals with one or more of the following: exertional leg symptoms, nonhealing wounds, aged 65 years and older, or aged 50 years and older with a history of smoking or diabetes.


ABI is the only cardiovascular disease diagnostic test that can be applied in an age-defined clinical population with such a high detection rate with low to no risk and low cost. However, the ABI recommendation is intended for office-based and vascular laboratory diagnostic use and is not intended as a population screening tool. 


Rooke TW et al. Circulation. 2011;DOI:10.1161/​CIR.0b013e31822e80c3.